The American College of Obstetricians
and Gynecologists (ACOG) Committee on Obstetric Practice has
issued recommendations for the administration of antenatal
corticosteroid therapy for fetal maturation. According to
the committee opinion, corticosteroid administration before
anticipated preterm birth is one of the most important
antenatal therapies available to improve new-born outcomes.
ACOG recommendations include:

A single course of corticosteroids is
recommended for pregnant women between 24 0/7 weeks and 33
6/7 weeks of gestation, including for those with ruptured
membranes and multiple gestations. It also may be considered
for pregnant women starting at 23 0/7 weeks of gestation who
are at risk of preterm delivery within 7 days, based on a
family’s decision regarding resuscitation, irrespective of
membrane rupture status and regardless of fetal number.

Administration of corticosteroids for
pregnant women during the periviable period who are at risk
of preterm delivery within 7 days is linked to a family’s
decision regarding resuscitation and should be considered in
that context.

A single course of betamethasone is
recommended for pregnant women between 34 0/7 weeks and 36
6/7 weeks of gestation at risk of preterm birth within 7
days, and who have not received a previous course of
antenatal corticosteroids.
Regularly scheduled repeat courses or serial courses (more
than 2) are not currently recommended.

A single repeat course of antenatal
corticosteroids should be considered in women who are less
than 34 0/7 weeks of gestation who have an imminent risk of
preterm delivery within the next 7 days, and whose prior
course of antenatal corticosteroids was administered more
than 14 days previously. Rescue course corticosteroids could
be provided as early as 7 days from the prior dose, if
indicated by the clinical scenario.

Continued surveillance of long-term
outcomes after in utero corticosteroid exposure should be
supported.
Quality improvement strategies to optimize appropriate and
timely antenatal corticosteroid administration are effective
and should be encouraged.